低龄、低体重儿童肾移植2例

doi:10.19723/j.issn.1671-167X.2025.04.028

摘要/Abstract

摘要：

肾移植是儿童终末期肾病的最佳治疗方法，能够改善患儿生长发育，提高患儿生活质量，但是，对于低龄(< 5岁)、低体重(< 15 kg)儿童的肾移植，因患儿血管纤细、手术空间狭小、围术期管理复杂等原因，仍面临很多临床困难。本文报道了北京大学人民医院2例低龄、低体重儿童肾移植：病例1，男，2岁3个月，体重8.8 kg；病例2，女，3岁8个月，体重11.25 kg。均采用经腹膜外途径，供肾动脉和静脉分别与髂总动脉、髂总静脉行端侧吻合，输尿管与膀胱以隧道法吻合，手术过程顺利，术后患儿肾功能恢复良好，均未出现血栓、输尿管狭窄或腹腔间隔室综合征等并发症。结合既往低龄、低体重儿童肾移植的文献报道，以及目前此类肾移植的全球发展现状，讨论低龄、低体重儿童肾移植的临床管理思路，探讨腹腔内途径与腹膜外途径两种手术策略的选择。本中心采用经腹膜外途径完成的2例手术，取得了良好的疗效，希望能为低龄、低体重患儿肾移植提供单中心经验。

关键词: 儿童, 肾移植, 低体重, 手术后并发症, 围手术期

Abstract:

Kidney transplantation is widely recognized as the optimal treatment for children with end-stage renal disease (ESRD), offering significant improvements in growth, development, and long-term quality of life compared with prolonged dialysis. However, kidney transplantation in low-age (< 5 years old) and low-weight (< 15 kg) children presents significant clinical challenges due to their delicate vascular structures, limited surgical space, and complex perioperative management. This report presents two cases of kidney transplantation in low-age, low-weight children performed at Peking University People' s Hospital. Case 1: a 2-year-3-month-old boy (8.8 kg), presenting a preoperative serum creatinine of 248 μmol/L post-dialysis and the estimated glomerular filtration rates (eGFR) of 35.17 mL/(min·1.73 m²). Case 2: a 3-year-8-month-old girl (11.25 kg), presenting a preoperative creatinine of 281 μmol/L post-dialysis and the eGFR of 22.63 mL/(min·1.73 m²). Both recipients underwent transplantation via the extraperitoneal approach, with end-to-side anastomosis of the donor renal artery and vein to the recipient' s common iliac artery and vein, respectively. The ureters were anastomosed to the bladder using the tunnel technique, and double-J stents were placed intraoperatively. The surgeries were uneventful, and both patients exhibited rapid recovery of renal function. Postoperatively, serum creatinine levels decreased to 26 μmol/L (Case 1) and 39 μmol/L (Case 2) by the third day, with the eGFR reaching 245.23 mL/(min·1.73 m²) and 164.12 mL/(min·1.73 m²), respectively. No complications, such as vascular thrombosis, ureteral stenosis, or abdominal compartment syndrome were observed during follow-up. A comprehensive literature review was conducted to contextualize these cases within global advancements in pediatric renal transplantation. Current evidence highlights the growing adoption of kidney transplantation for low-age, low-weight children, though debates persist regarding optimal surgical strategies (specifically, the intraperitoneal versus extraperitoneal approaches). This case report underscores the feasibility of the extraperitoneal approach in overcoming anatomical limitations of low-weight pediatric recipients, with distinct advantages including reduced gastrointestinal complications and enhanced accessibility for post-operative ultrasound monitoring. Furthermore, mean arterial pressure (MAP) and central venous pressure (CVP) were systematically monitored intraoperatively to ensure optimal renal blood perfusion and graft viability. Our single-center experience provides valuable insights into surgical strategy selection and perioperative management for this high-risk population. Nevertheless, larger multicenter studies are warranted to validate long-term outcomes and refine standardized protocols.

Key words: Child, Kidney transplantation, Low-weight, Postoperative complications, Perioperative period

中图分类号:

R726.9

赵兆, 张维宇, 杨文博, 张勇杰, 张晓鹏, 赵慧颖, 周刚, 王强. 低龄、低体重儿童肾移植2例[J]. 北京大学学报（医学版）, 2025, 57(4): 803-807.

Zhao ZHAO, Weiyu ZHANG, Wenbo YANG, Yongjie ZHANG, Xiaopeng ZHANG, Huiying ZHAO, Gang ZHOU, Qiang WANG. Kidney transplantation in low-age, low-weight children: A report of two cases[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 803-807.

图/表 1

图1

参考文献 32

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